A Professor of Medicine and Consultant Cardiologist, S.A. Isezuo, has identified salt consumption, especially in high volume as the major cause of high blood pressure (HBP) in most Africans, as findings have validated it that black people excrete salt poorly than whites.
The cardiologist from the Usmanu Danfodiyo University Teaching Hospital, Sokoto, asserted that despite the availability of many antihypertensive drugs, the most adequate antihypertensive drug for the black population is yet to be determined.
He further explained why intake of salt triggers HBP, saying it is related to a condition called salt sensitivity- which he describes as a rise in BP during salt administration and/or a fall in BP when it is restricted. Salt sensitivity is a likely physiological contributor to: salt and water retention, plasma volume expansion, renal vasoconstriction especially in those with low potassium, salt sensitivity directly correlates to rise in BP and microalbuminuria, among others.
The human heart specialist, however noted that the genes underlying hypertension in blacks are believed to have evolved naturally, as a result of their adaptation to hot climate condition, particularly in people living in Sub-Saharan Africa.
Isezuo, who was one of the speakers at the webinar, organised by Neimeth International Pharmaceuticals Plc, to commemorate the 2021 World Hypertension Day said if nothing is done to urgently stem the global prevalence of the disease, it is estimated that 1 in 3 adults from 20 years and above will be hypertensive in 2025.
He therefore stressed the need for Nigerians to intentional reduce their salt consumption drastically, as a means of preventing the development or progression of HPB. He highlighted the evidence-based best antihypertensive medicine for blacks as follows: “Low salt Dietary Approach to Stop Hypertension (DASH) plus diuretic; Combination therapy with diuretics and calcium channel blocker or any of these with ACEI/ARB/BB (C A), if BP is greater than 15/10 mmHg above goal; Rarely low salt plus DASH with diuretics or CCB monotherapy; When used as monotherapy, ACEI, ARB and BB are not as effective as diuretic or CCB (A).
“The pathogenesis of HBP in blacks is multifactorial: interaction between obesity, salt sensitivity and activation of the RAAS, among other causes. The understanding of how these factors influence BP will guide the development of treatment protocols and future therapy. Diet, lifestyle modifications and considerations for barriers to BP control must be part of all treatment regimens”, he recommended.
Dr Tricia Cookey-Gam Nwamaka, deputy director, Obstetrics & Gynecology Department, University of Port Harcourt Teaching Hospital (UPTH) also spoke on Pharmaceutical Care and Hypertension during the webinar, emphasising pharmacists’ roles in drug management and counseling.
She said the ultimate goal of Pharmaceutical care is optimisation of drug use and improving health outcomes by; identifying potential and actual drug therapy problems (DTPs), resolving these problems and preventing the potential DTPs from becoming actual DTPs for the patient and therapy outcomes.
Defining hypertension as the persistent elevation of atrial blood pressure (diastolic and / systolic equal to/above 140/90 mmHg in an adult of 18 years or older, she urged pharmacists to always endeavour to give proper counseling to hypertensive patients, knowing that it requires life –long medication and lifestyle management.
She said specific patients counselling must let them know that: “Raised blood pressure damages major organs, in addition to lifestyle modifications, medication is life-long, medications are taken same time daily, preferably in the evening, diuretics are to be taken in the morning to avoid nocturnal diuresis, co- administration of orthodox and herbal preparation are discouraged, ACEI s may produce a disturbing dry cough, especially in obese patient, methyldopa may cause postural hypertension and are contra-indicated in pregnant women with a history of depression . In men, it causes erectile dysfunction”.
The organisers of the programme, Neimeth International Pharmaceuticals Plc, also seized the avenue to remark on the effectiveness of their brand of antihypertensives in the management of HBP.
Their anti-hypertensives brand are: Norduet – amlodipne, which comes in 5 or 10mg/hctz 12.5mg; Miniplus – prazosin, 0.5mg/hctz 12.5mg; Normoretic – amiloride, 5mg/hctz50mg, and Amovar – amlodipine 5 and 10mg, remains the company’s trusted brand of amlodipine which assures adequate blood pressure control in the event of a missed dose.